Health Care

2:10 pm

Thu May 30, 2013

Hospital Reviews, Take Them With A Grain Of Salt

There's all kinds of information available these days that allows consumers to compare hospitals - ratings on patient satisfaction, on outcomes, amenities and infection rates. But in the piece this week for The Atlantic, Doctor Richard Gunderman writes that those criteria, they might help us shop for a new car but they don't apply to hospitals. For example, even if hospitals - excuse me. For example, even if patients report outstanding care, he writes, we may not be able to tell whether or not the hospital staff arrived at the correct diagnosis, prescribed the appropriate therapy or delivered the medications and procedures in a competent fashion.

So when you're not racing to the nearest ER and have time to shop around, how do you choose a hospital? 800-989-8255. Email us: talk@npr.org. Doctor Richard Gunderman is vice chair of the radiology department at Indiana University. He's also a professor at Indiana University-Purdue University Indianapolis and joins us now by Skype from his office in Indianapolis. And Doctor Gunderman, nice to have you on TALK OF THE NATION today.

RICHARD GUNDERMAN: It's a pleasure to join you, Neal.

CONAN: The amount of information on hospitals these days can be bewildering - billboards, commercials and websites for reviews. How do people even start to sort through all that?

GUNDERMAN: I think that's an important question, Neal, and it's becoming increasingly important as hospitals compete with one another for our business as patients. And I have to say, there are some reasons some of us can't choose a hospital. As you point out, if you find yourself in the back of an ambulance, you're probably not too concerned about hospital choice. Other people are constrained either by their physician's admitting privileges, so does my doctor admit patients to the hospital I'm interested in? And the third issue would be, does my insurance cover care at the hospital I'm interested in?

But for many of us, even when - with those provisos we still have some choice about what hospital to receive our care at. And if you just went by what you see on the billboards as you drive around town, you might conclude that you have multiple top 100 or even number one hospitals in your area, and the choice between them can be quite bewildering.

CONAN: So there are all these new informations, this data available that tells you how hospitals compare on various bases.

GUNDERMAN: That's exactly right. And I suspect - if it's confusing to me as a health professional, a practicing physician who takes care of patients in the hospital, I suspect it must be even more daunting for a lot of people who don't have backgrounds in health care.

CONAN: So if you're getting a, let's say, heart surgery, for example, wouldn't you try to find the place that had the best outcomes?

GUNDERMAN: Yeah, I think that's a reasonable course of action if you can. And data are out there about the quality of care for particular types of medical conditions or surgical procedures you might need, but those data aren't always clear. And sometimes they might make us more confused than clear on where the best place to get care would be. For example, hospitals might talk about their readmission rates or the rates at which patients develop infections while they're in the hospital, and those are very important. And all of us in health care are working hard to make those numbers look better. We don't want to make anyone sick when they're under our care.

But of course there are other factors that go into those numbers beyond how well we practice medicine and deliver nursing care. One issue, of course, would be how healthy was the patient when he or she arrived at the hospital? In other words, if you're taking care of patients who are quite a bit sicker to begin with, it's quite probable that your outcomes won't be as good even though you're providing equally good or in some cases perhaps even better care.

CONAN: So, just for example, the sickest patients might go to the place that is, in fact, the best, and because they're the sickest to begin with, their numbers don't look quite so good.

GUNDERMAN: That's exactly right, Neal. So, you know, just to look at a column of figures and say, you know, this hospital rates - I'll make up a number - a 98. This hospital rates a 96. Well, surely, I would prefer the hospital with the 98 rating. But, in fact, when you dig more deeply, those numbers probably can't be taken at face value, at least not in all cases.

CONAN: So if that's not a good criterion, what about patient satisfaction? I mean, surely, that's a good measure.

GUNDERMAN: Well, you know, I think it's very important to take account of the perspectives of patients. If all the patients who go to a particular doctor or a particular hospital are disgruntled afterward, that's a sign there's a serious problem. But, again, patient satisfaction scores can be skewed, can be tilted for all sorts of reasons that don't necessarily have to do with the quality of medical care. For example, how easy was it for me to find parking at the hospital, and did I have to pay for parking? And if so, how much did it cost? What was the quality of the food service? What degree of selection did I have about the food that was served to me?

You know, even things that some of us might regard as luxuries - what's the quality of the art that adorns the hospital's hallways, or do I have access to a masseuse? You know, to some people, those things are important and may enter into their evaluation of how satisfied they were with their hospital experience. But on the other hand, you know, you're choosing a hospital at which to have brain surgery or heart surgery, you might say that the availability of a masseuse or a gourmet chef wouldn't be a high priority.

CONAN: Or the parking. In any case, we'd like to get some callers in on this conversation. When you do have a choice - when you're not in the back of the ambulance - what criteria do you use to select which hospital to go to? 800-989-8255. Email us: talk@npr.org. And Charlie's on the line with us from Milwaukee.

CHARLIE: Hi. Great program, as always.

CONAN: Thank you.

CHARLIE: I'm a physician. And what I look at for the physicians that treat me or my children or my wife, I always look at what they are doing, and then I do my own research. And, in fact, I'm an intensivist. When I'm dealing with patients, I often tell them the diagnosis, and I invite them to go online and do their own research. And we will go over that, myself with them, so that they can understand what I'm doing and why. And if they have any questions, I tell them all the time, the world's shortest pencil's better than the world's longest memory. Write it down, bring the question to me, and we'll discuss it so that all their questions are answered.

CONAN: And what is - what are some of the really good questions you get?

CHARLIE: Well, a lot of times, the questions deal with prognosis, or the questions deal with kind of the fringe-type of therapies. And when that happens, the parents will ask - or the patient will ask for a certain things, and I will show them in the textbook or in another, you know, recently written textbook that there - what is being spouted on the Internet is a little more of a fringe-type therapy, and not necessarily the standard of care for what's going on. So the questions can be varied from which antibiotic to use, how to feed. More than anything, it allows the parents or the patient to have some control in their - in the care.

CONAN: Dr. Gunderman, that sounds like an awful lot of consultation. A lot of doctors don't have that kind of time with their patients.

CHARLIE: Actually, actually, can I just butt in and say that's not really - it doesn't have to be 30 minutes every day. What it ends up being with each patient is just telling them briefly, do you have any questions? And they can say, simply, I read last night X, Y or Z. And it's very easy, in one or two sentences, usually to say I'm doing this because of, you know, A, B, C. And it's not as difficult, especially if the parents or the patients feel that they can look at the Internet, read what it is, they have an understanding. And if that happens, the clarification is easier for everyone.

CONAN: Dr. Gunderman?

GUNDERMAN: Neal, Charlie sounds to me like an exemplary physician. I love the way he's encouraging patients to do their own research, so to speak, using the Internet and other resources. And I really like the collaborative relationship he strives to develop and maintain with his patients. And I think that's terrific, and you could put that to work in choosing a hospital, as well.

But we need to remind our patients - and sometimes even we physicians need to remind ourselves - that the information we find, say, with an Internet search, isn't always necessarily accurate. And sometimes, even if it's accurate, it can be superficial. In other words, what it's saying is true, but perhaps there are some questions - very important questions - that it isn't addressing. And that's something that I think, ultimately, many of us need to turn to health professionals - doctors, nurses - for advice and consultation about the meaning of what we're finding in our own research.

CHARLIE: And I must report that I've had trouble with sometimes, when you try to do this, to act as a team, that it can put nurses on the spot, your partners on the spot, and sometimes it can lead to other difficulties. So it's not the panacea, but it's just an attempt to try and improve communication, and you try to do that all the time. But, again, it's not without its own problems because, as you said, sometimes people can get the wrong idea, and then it's really hard to change things.

CONAN: Charlie, thanks very much for the phone call. Appreciate it. We're talking today with Dr. Richard Gunderman, vice chair of the radiology department at Indiana University, professor at Indiana University-Purdue University Indianapolis. He wrote a piece called "Finding the Right Hospital" for The Atlantic's website. You can find a link to that piece at our website. Go to npr.org. Click on TALK OF THE NATION. And this is TALK OF THE NATION, coming to you from NPR News. And let's get Matt on the line. Matt's with us from Sheridan, Wyoming.

MATT: Yeah. I just had both of my knees operated on. And before I did, I had a total knee replacement. We looked into hospitals, and the infection rate was big piece for us choosing one. And in our small town here in Wyoming, their procedure isn't quite up-to-date. We're a little bit behind nationally on knee surgeries, but we decided to go here, A, because of the infection rate, and B, just trusting the doctor and the relationship that we had with the doctor here in our town. And sure enough, I did have an infection.

And on a Saturday, after a hunting trip, my doctor actually came and got me some antibiotics, and it was great. And I just think the relationship with the doctors is a huge piece of the puzzle.

CONAN: Dr. Gunderman, is infection rate a critical factor?

GUNDERMAN: It probably depends on what kind of care you're going to receive, Neal. But this much we know, about in one and 20 patients who are admitted to a hospital will develop an infection which requires further treatment, sometimes, you know, making a patient sicker, sometimes prolonging the hospitalization. I would be very interested in infection rate, particularly for some surgical procedures. Good examples would be hip replacements and knee replacements, because that would be one of the more serious complications you could have if you underwent that procedure.

And I think he makes a terrific point. An important factor with where you go to the hospital is how close is the hospital to your home? Will relatives and friends be able to visit you? You know, you might say, gee, the best hospital in the country is 1,000 miles away. I should go there. And perhaps their statistics look somewhat better. But on the other hand, the advantage of being close to home, close to those who can help care for you, perhaps even stay with you in the hospital during the most important parts of your hospitalization may outweigh the benefit of a slightly better statistical average.

CONAN: Matt, thanks very much. And everything worked out OK?

MATT: Yeah. It's great.

CONAN: OK.

MATT: I'm not running, but power walking.

(LAUGHTER)

CONAN: Good for you. Stay with it.

MATT: Thank you.

CONAN: All right. Let's see if we can go next to - this is Cathy(ph) , Cathy with us from Columbus.

CATHY: Hi, Neal.

CONAN: Hi. Go ahead, please.

CATHY: Well, I'm actually on my way to work now. I work as an operating room nurse. And I have found that your first line of people to inquire is with the staff. I think the nurses and the surgical techs and all the way down to the orderlies all know what goes on behind the scenes. And if there's a way that you could speak to them or if, you know, you know people in your neighborhood that are nurses, they can kind of give you the 411 on things.

CONAN: Many of us don't have that option, though.

CATHY: Well, I understand that. But as I look to retirement and maybe moving out of state, one of things I plan to do is to - if I don't work in a hospital setting, at least go and check them out. And you can get a lot of this information from your doctor or you surgeon. They will have good information for you. But I still say that it lies with the staff, and they can give you, you know, the information regarding, you know, how lax their standards are, how much do they adhere to them.

CONAN: How would you - let's say you went on retirement and you moved to, I don't know, Cincinnati. How would go about finding the best hospital - where would you go to meet those nurses and orderlies?

CATHY: I would probably go to the hospital itself.

CONAN: Ah-ha, to lurk in the corridors and...

(LAUGHTER)

CATHY: Oh, you don't have to lurk. But I think you could - if you're not in waiting area or - and I know that (unintelligible) recently started evaluating medical personnel.

CONAN: Uh-huh. That they do. Well, Cathy, good luck with your retirement, and we hope that you are happy wherever you go.

CATHY: Thank you.

CONAN: Appreciate it. Dr. Gunderman, talk to the staff. Is that a good idea, if you can?

GUNDERMAN: Well, I think it's a terrific idea, Neal, if the opportunity presents itself. I think, finally, one of the best ways to tell the quality of care you're likely to get into a hospital is to look at and talk with the people who work there, especially nurses and physicians. Do they seem happy in their work? Do they seem proud of the work they're doing? I think - if the answers to those two questions are yes, you're probably on the right track.

CONAN: Dr. Gunderman, thank you very much for your time today. We appreciate it.

GUNDERMAN: It's been a pleasure. Thank you, Neal.

CONAN: Richard Gunderman, professor at IUPUI, vice chair of radiology at Indiana University. His Atlantic article again, "Finding the Right Hospital," and there's a link to it at our website. He joined us by Skype from his office in Indianapolis. Tomorrow, TALK OF THE NATION: SCIENCE FRIDAY with a look at the new edition of the DSM, and guest host Ari Shapiro will be here on Monday. I'm Neal Conan. It's the TALK OF THE NATION, from NPR News. Transcript provided by NPR, Copyright NPR.